Keeping Teenagers Out Of Clinics

Jordan Barab, who apparently knows exactly what it takes to get me frothing at the mouth in incoherent fury, called my attention to this Effect Measure post about Texas laws limiting adolescents' access to reproductive health care.

Some teenagers tell their parents everything. Some tell them nothing. They want none of that in Texas. In an effort to discourage adolescent sexual activity, Texas lawmakers have passed a law that requires parental consent for girls under 18 to receive prescription contraceptives. There is more. Health care providers must report to law enforcement officials the identity of patients 17 and under who seek reproductive health care services since sexual contact with a person of this age is illegal in Texas.

Only someone brain dead would expect such a policy to have much effect on teenage sexual activity but you can be pretty sure it will have an effect on care seeking behavior in this age group.

My first reaction, after all the swearing, was, "Why the hell haven't I heard anything about those laws?" And my shock deepened when I learned that the laws date to 2003 (for the contraceptive prohibition) and 2001 (for the mandated reporting of adolescent sexual activity). I did discover, at least, that the law mandating reporting of sexual activity only applies when the partners are at least three years apart in age.

The Guttmacher Institute has released two excellent reports examining the issue of parental consent for minors seeking health services. Most states exempt reproductive health services from parental consent laws based on the assumption that it may discourage minors from seeking needed treatment. And research suggests that it does - a 1999 study published in the Journal of the American Medical Association found that a substantial percentage of adolescents have avoided seeking health care because of confidentiality concerns, and a 2002 study found that 47% of adolescents receiving reproductive health care services at public clinics stated that they would no longer seek health care if their parents were notified. (A much, much, much smaller minority said that they would stop having sex.)

A recent Texas study attempts to put a price tag on the public health costs that would result from adolescent girls abandoning reproductive health services as a result of the changes to Texas law. They estimate that approximately 37% of girls currently receiving care would no longer do so, and report:

This would result in an additional 11.45 pregnancies, 7.44 births and 2.29 abortions per 100 teenagers, costing approximately $61,000 per 100 girls.

Also, the estimated increase in sexually transmitted diseases would cost $980 per 100 teens.

The projected overall cost is approximately $43.6 million per year, Franzini's team reports. Even so, that figure underestimates "the true costs to society because they include only direct medical costs,"

Even the direct-cost estimates seem low to me, actually, because they don't figure in increased costs from pregnant adolescents avoiding prenatal care. Lack of prenatal care is strongly related to an increased risk of birth complications and poor infant health outcomes - and yet, if you're a pregnant 16-year-old who knows the obstetrician will be required to report you to the police for getting pregnant, those distant health outcomes probably aren't as much on your mind as the hell that will break loose at home if the police show up at your door.

Texas isn't alone in its use of statutory rape laws to discourage consensual sexual activity by minors: in 2003, the Attorney General of Kansas issued an opinion that health care providers must report to law enforcement anyone under the age of 16 who seeks an abortion, prenatal care, birth control, or STD treatment. Fortunately, the Center for Reproductive Rights has been able to secure an injunction preventing the Kansas directive from going into effect while a challenge works its way through the courts.

There's no doubt that some teenaged girls are preyed upon by much older partners. Research indicates that the younger a girl is when she first has sex, the higher the likelihood that her partner is not another adolescent, but an adult. One study found that, among pregnant 15-year-olds, 40% had been impregnated by a man who was at least 20 years old. (Age gaps tend to be significantly smaller for older teenagers.) Age of consent laws, when applied with careful discretion, can be an important tool in protecting girls from exploitation by adult men. And there have been a few shocking, high-profile cases in which reproductive health clinics failed to protect girls who quite obviously needed help. For example, in 1998, an Illinois clinic failed to report a 37-year-old teacher who brought his 14-year-old student and sexual partner in for birth control.

But the Texas law and the proposed Kansas legal interpretation leave no room for discretion. The result is actually less protection for exploited minors, not more:

Peggy Romberg, CEO of the Women's Health and Family Planning Association of Texas, notes that statutory rape reporting among family planning providers has gone up substantially because of changes to Texas law. As a result, law enforcement agencies have been inundated with reports, with most ending up in file drawers with no action taken. "Historically, we [family planning providers] have been the partners of law enforcement agencies in identifying and reporting actual sexual abuse of teens, including by inappropriate adult partners. When we filed a report, law enforcement agencies took it seriously. Now that we are no longer allowed to exercise our discretion, there is a lot more reporting going on, but the police are ignoring most."

In 1977, the Supreme Court affirmed minors' rights to access contraception and other reproductive health services in Carey v. Population Services International. The majority ruled that

(a) The right to privacy in connection with decisions affecting procreation extends to minors as well as to adults, and since a State may not impose a blanket prohibition, or even a blanket requirement of parental consent, on the choice of a minor to terminate her pregnancy, Planned Parenthood of Missouri v. Danforth, 428 U.S. 52, the constitutionality of a blanket prohibition of the distribution of contraceptives to minors is a fortiori foreclosed. Pp. 693-694.

(b) The argument that sexual activity may be deterred by increasing the hazards attendant on it has been rejected by the Court as a justification for restrictions on the freedom to choose whether to bear or beget a child. Eisenstadt v. Baird, 405 U.S. 438, 448; Roe v. Wade, 410 U.S. 113, 148. Moreover, there is substantial doubt whether limiting access to contraceptives will, in fact, substantially discourage early sexual behavior. When a State, as here, burdens the exercise of a fundamental right, its attempt to justify that burden as a rational means for the accomplishment of some state policy requires more than the unsupported assertion (appellants here having conceded that there is no evidence that teenage extramarital sexual activity increases in proportion to the availability of contraceptives) that the burden is connected to such a policy.

The Supreme Court has repeatedly ruled (for example, in Belloti v. Baird and Ohio v. Akron Center for Reproductive Health) that parental notification or consent requirements for minors seeking abortions must be accompanied by a judicial bypass procedure through which minors can avoid involving their parents. The Texas birth control law includes no such bypass; as such, given Carey v. Population Services International, it is probably unconstitutional. Right now, Texas reproductive health care providers are getting around the law by directing all of their federal family planning funds (also known as Title X funds) towards services for adolescents. Title X services have confidentiality mandated by federal law and cannot be superceded or restricted by state laws. Still, that's only a temporary solution. The confidentiality of Title X services is constantly under threat; efforts to undermine Title X are a common pet project of social conservatives. So hopefully, a Supreme Court challenge of the Texas law is underway. Fast. Before Bush gets a chance to put anyone on the Supreme Court.

Playing Connect-The-Dots

It's funny how news stories look completely different, sometimes, when you string them together in a line.

Garance Franke-Ruta brought my attention to a David Brooks column in which he waxes rhapsodic about a phenomenon he calls "natalism," in which white people move to the suburbs and have babies. (As Slacktivist points out, this is supposed to be a novel phenomenon?) It turns out, from what I can gather from Brooks's column, that only white suburbanites really find parenthood "enriching and elevating" in a spiritual sense. Seriously: Brooks makes it clear that he's only talking approvingly about higher white fertility rates. (Garance did the work of tracking down the white supremacist Brooks cites, so, mercifully, I don't have to.)

It also turns out that these white suburban "natalists" tend to vote Republican. Brooks suggests that this is because, when people become parents, they are driven to protect their children from pernicious influences like Janet Jackson's boob and the First Amendment.

But I got to thinking about another interpretation, based on a chart I'd seen at Daily Kos, just yesterday. It turns out that, in addition to carrying "the 19 states with the highest white fertility rates, and 25 of the top 26," Bush also just happened to carry 20 of the top 21 states with the highest teen pregnancy rates. And in addition to winning the "16 states with the lowest [white] fertility rates," John Kerry also won 14 of the 16 states with the lowest teen pregnancy rates. Hmm. Suddenly Red-State "natalism" seems a lot less desirable.

(And why is the teenage birthrate so high in the Bible Belt? Maybe because of the questionable things they're learning in those popular Red State abstinence-only sex ed classes.)

But the mention of classes reminds me of yet another well-known difference between Red States and Blue States. (See what I mean about how these news stories cascade, in my head?) Kerry mostly took the 10 states placing the highest value on education, while Bush took most of the bottom 10. We know that women who are more highly educated have fewer children than women with less education. In fact, worldwide, the education and empowerment of women is one of the strongest predictors of fertility rates. Put simply, women who have more options, more freedom, and more social power have fewer children.

(What's the moral pointed out in that abstinence-only curriculum, again? "Occasional suggestions and assistance may be alright, but too much of it will lessen a man's confidence or even turn him away from his princess." Because, apparently, if you're going to keep the birth rate up, you've got to keep the women down.)

My research also came up with the grisly statistic that infant mortality is 57% higher in Red States than Blue States. I don't think I want to poke at that one any more closely, except to say that high infant mortality rates and higher fertility tend to co-occur.

So the more I poke at Brooks's assumption that higher fertility rates, excuse me, higher white fertility rates say something good about Bush states, the less justified it seems. I'm not saying that I've got the definitive explanation for why birth rates are higher in Bush country, but it does seem likely that it involves something less sweet and simple than a starry-eyed belief in parenthood as "enriching and elevating."

But that may just be me: barefoot, pregnant, and hanging my Ph.D. diploma on the wall of an urban Blue State home. What do I know about natalism?

Roz Kaveny shares a heartening story today. Apparently, a prominent conversion ministry and "ex-gay" organization in Britain has had a radical change of heart:

Our non-negotiable view regarding homosexuality, promoted the belief that ‘the answer’ was either to be found through the possibility of change-’to become heterosexual as God intended’, if this was the heart’s desire of the person seeking help, or at the very least to live a celibate life. We believed such objectives could be realised through a lifestyle of ongoing repentance, devotion to Christ and a willingness ‘to deal with the deeper issues’ (e.g. abuse, rejection, lack of bonding to the same-sex parent, etc.). [...]

After ten years, however, six spent running residential discipleship courses, followed by years of weekly group meetings, it was increasingly clear that however repentant people were, and however much dedication and effort they put into seeking change, none were really ‘successful’ in the long term in ‘dealing with the deeper issues’. This is not to say that people gained no benefit! Many matured greatly. A few married (though their same-sex attractions remain an ongoing issue for them). But the kind of change everyone really hoped for – to re-orientate and reach a point where their struggle with being gay was over – remained elusive. We never saw the fruit we longed for. [...]

Clearly the sense of alienation from God (and from themselves) that many lesbian and gay people have experienced, also the guilt and shame, has contributed nothing to godly living, never mind healing. So how can we, with any integrity, proclaim a message of ‘healing’ from homosexuality if God is not supporting it? Moreover, I do not see what scriptural basis we have for doggedly insisting that any and every form of erotic expression outside monogamous heterosexual marriage is sinful.

Everyone needs to know the unconditional love of Christ; gay people are no exception. While it may be argued that pursuit of ‘casual sex’ calls for repentance, from years of persistent prayer and Bible study, I’ve concluded that there is scope in scripture for acceptance of committed, intimate same-sex relationships. This is not an ‘anything goes’ approach-anyone seeking to be Christ-centred will naturally yearn to find a basic moral framework and ethos for gay and lesbian relationships.

By the year 2000, it had become clear that God was requiring of our ministry a marked change of attitude, outlook and policy.

As a psychotherapist and as a person of faith, one of the things that keeps me from despair is my belief that change is always possible - that no matter how hopeless a situation appears to be, the people within it can change. Some days it's easy to believe that. Some days it's harder.

These folks prayed for a healing change, and it came to them in a form that was utterly unexpected. They had the courage to embrace it anyway - even knowing that it would separate them from some of their strongest supporters. Good for them! They restore my faith in human possibility.

More Human Guinea Pigs

Several people (for example, here) have criticized my last post as paying insufficient attention to the charge that children were being removed from parental custody if parents declined to participate in research. Re-reading my original post, I can see how it might be read by someone who doesn't know me as, "AIDS clinical trials are good, so it's okay that people were forced into them." Of course that's not what I meant to convey at all.

Take a look at the full transcript of the documentary. I read it through, trying to find an example of a parent or guardian who lost custody for refusing experimental participation. There are two candidates: the story of the guardians of a child named Garfield, presented in the first five minutes, and the story of the nurse Jacklyn Hoerger, which is covered at length in the second half of the documentary. Let's look at both of them closely, plus a third story in one of the Liam Scheff pieces that served as source materials for the documentary.

According to the transcript, Garfield's aunt and grandmother had concerns about side effects of his prescribed medications, so they stopped the meds. At the urging of his doctor, meds were re-started. When the family asked the doctor if they had any other options, he suggested that they could enroll in a clinical trial. They refused, and (again, according to the transcript):

Regina’s daughter took Garfield off all medication. Almost immediately his health improved. Then there was a knock on the door.

In other words, this family didn't lose custody for refusing to participate in the clinical trial, they lost custody for refusing to provide Garfield with any medical treatment whatsoever for HIV. The family says "his health improved" off meds, but anyone familiar with the course of HIV knows that labwork tells the true story. If the child's CD4+ cell (T-cell) count were declining rapidly, for example, then it would be perfectly reasonable for his physicians to believe that withholding all treatment constituted medical neglect - and to report it to the state authorities.

The Liam Scheff article carries a similar story about a great-aunt who withheld all conventional medical treatment from her HIV-positive wards, instead taking them to a naturopath. Again, this was not a case in which she lost custody for refusing to participate in clinical trials, it was a case of refusing all conventional, approved, treatments for HIV. (She says she refused "AZT, Nevirapine, Epivir, Zerit," the latest of which was approved in 1996. The children were taken from her custody four years ago.) One of the children subsequently participated in a clinical trial at Incarnation Children's Center, but no details are given as to the nature of the study. Participation in a clinical trial might involve an experimental drug or combination, but it also might involve something as trivial as a change in dosage times - for example, testing the efficacy of once-a-day Epivir over twice-a-day Epivir. In any case, there is no suggestion whatsoever that she lost custody for refusing participation in clinical trials. She lost custody for refusing to treat the children with any approved HIV medications at all.

Jacklyn Hoerger's story takes up almost half of the BBC documentary, and more details are given in a Liam Scheff profile. The profile makes it clear that Hoerger also stopped all medications for the children in her care. Not experimental medications - the only drugs she mentions by name are Nevirapine and AZT, both FDA-approved before the children came to live with her in 1996 - but all medications:

I was looking for answers, so I went to a lecture on HIV by Philip Incao, an MD with a background in Holistic Medicine. He talked about problems with the HIV diagnosis, the toxicity of the drugs and their effect on the immune system. What he said made me feel angry and threatened.

I confronted him after the lecture. I said, “I have two HIV positive children in my home right now, and you’re recommending that I take them off the drugs?” He said “Yes” “The drugs are too toxic for children.” He said that he had a better way to treat them and to strengthen their immune systems. He told me to read the book “What If Everything You Thought You Knew About AIDS Was Wrong,” by Christine Maggiore.

I read the book, and I spoke with medical professionals who all advised me that the drugs were harmful. I researched the drugs myself and reached the same conclusion. And for a good number of months, I struggled. I knew that Catholic Home Bureau and ICC wouldn’t support this, even if it was the best thing for the children’s health and survival. I had long consultations with Dr. Incao about what complementary and holistic medications to give the girls to support their immune systems. And after a great deal of research and thought, I took them off the drugs.

Although Hoerger had begun the adoption application process, at the time that she stopped all treatment, she had not legally adopted the children - they were in foster care with her. That made the state their legal guardians, not Hoerger. So this case has nothing whatsoever to do with parental rights. The state had the legal responsibility to make sure those children got adequate medical care, because they were still wards of the state. It's hardly surprising that they wound up deciding that HIV-positive children should be cared for by people with mainstream beliefs about HIV. Consider the liability the state would be under - legal and moral - if the children had died from having FDA-approved HIV treatments withheld.

There seems to be no evidence that parents or guardians are losing custody of their children for refusing to participate in clinical trials. There is evidence that parents and guardians may lose custody for refusing all mainstream HIV care for their minor children. Again, as I said in my first post, one could have a legitimate discussion about the circumstances in which parents have the right to refuse medical treatment for children in their care. But it's simply inaccurate to say that these examples amount to children being taken away for the refusal to be "guinea pigs." Scheff and the BBC filmmakers have produced no evidence of that.

"Human Guinea Pigs?"

Apparently, on Tuesday night the BBC aired a documentary claiming that HIV+ children in foster care were used in horrific drug-testing experiments without the consent of their parents. The blogosphere is understandably aghast, hearing echoes of the Tuskeegee syphillis study or - worse - Nazi "medical experiments" involving the often-fatal torture of helpless victims.

I read the BBC article a couple of days ago, and it didn't sound right to me. Too much is missing - including anything that could be used to check the veracity of the story, such as the names of the experimental drug compounds or the names of scientists running the trials. Another detail that didn't ring true: the drugs were "supplied by major drug manufacturers including Glaxo SmithKline." Glaxo SmithKline is a major manufacturer of HIV drugs - I have several of their pens - but why the lack of specificity?

The language used in the BBC piece also seemed familiar. A vocal contingent of people oppose HIV medications, and they favor certain turns of phrase. "Human guinea pigs." "Experimental." "Toxic." They focus on side effects and subjective sensations to the exclusion of clinical or lab data. It's hard to pin down exactly, but when you've read enough of their writings you begin to recognize the tone. I heard that tone in the BBC article.

The story also broke my plausibility meter. Severely. I do research with human subjects for a living, and I have an excellent sense of the regulatory tangles and layers of oversight surrounding any research with human beings. For "protected classes" of research subjects, including children and institutionalized people, the rules are even more stringent. What happens when research protections are violated? Banner headlines and regulatory Armageddon. When a single research subject died at Johns Hopkins because of faulty study protections, the federal government didn't hesitate to shut down all human research of every kind at one of the foremost research institutions in the world. Gene therapy research was essentially halted nationwide for years because of a patient death which was linked to inadequate monitoring of research-related adverse events. Both incidents were widely covered in national news outlets, and they were everywhere in news sites for health research professionals. And yet there was not a word about the BBC documentary and its shocking allegations in Medscape or any of the other HIV sites I follow. That didn't seem plausible at all.

So I did some poking around, and instantly hit pay dirt. The documentary filmmakers state that:

We asked Dr David Rasnick, visiting scholar at the University of Berkeley, for his opinion on some of the experiments.

He said: "We're talking about serious, serious side-effects. These children are going to be absolutely miserable. They're going to have cramps, diarrhoea and their joints are going to swell up. They're going to roll around the ground and you can't touch them."

He went on to describe some of the drugs - supplied by major drug manufacturers including Glaxo SmithKline - as "lethal".

Dr. David Rasnick is an AIDS denialist. He doesn't believe that HIV causes AIDS. He doesn't believe that AIDS is contagious or sexually transmitted. He doesn't believe in protease inhibitors, the class of drugs which, since 1997, have caused a dramatic decline in AIDS diagnoses and deaths in the developed world. He thinks HIV drugs are the problem, not the solution.

The Guerrilla News Nework led me to some articles by a guy named Liam Scheff, which the BBC filmmakers purportedly used as the basis for their research. The GNN reprinted the BBC piece with a prefacing paragraph that listed some of the compounds in question: "chemotherapy drugs such as AZT, and potent cell-killing drugs like Nevirapine." (Perhaps those drugs weren't listed in the BBC piece because they would have diminished its shock value; AZT and nevirapine are well-established, FDA-approved HIV medications.) Scheff's articles make it clear that he's been talking exclusively to AIDS denialists like Christine Maggiore; he promotes the theory that HIV tests are wildly inaccurate and that naturopathic treatment is sufficient to prevent illness in HIV-positive individuals. Shocked by HIV drugs' potential for serious toxicities, he blames the medications for all the ills suffered by persons with HIV rather than balancing the risks of medication against the risks of untreated HIV. So there are gory color photos of Stevens-Johnson Syndrome, a rare but very serious medication side effect, but no pictures of untreated end-stage AIDS patients in Africa or from the pre-drug 1980s. There is no mention of the decline in death rates since protease inhibitors were introduced in 1997.

Scheff did document that children at the Incarnation Childrens Center participate in clinical trials, as large numbers of HIV patients do. There is nothing inherently wrong with conducting medical research with children - in fact, it is necessary. Medications proven to work in adults may not work the same way in children, so children need their own clinical trials. The law requires that children cannot be subjected to research-associated risks unless the potential benefit to the child far outweighs the level of risk involved. In other words, the vast majority of children who participate in potentially risky medical research are dying and otherwise out of treatment options.

That was particularly true in the late 90s, when many of these disputed studies apparently took place. At that time, participation in clinical trials was the only way to access new life-saving treatments like protease inhibitors. The existing treatments in the late 90s were highly toxic and largely ineffective, as you can deduce from the death-rate table I linked above. For many people, getting into a clinical trial rather than waiting for the protease inhibitors to be approved for release represented the difference between life and death. So, in that context, there's nothing inherently sinister about these children's guardians (the child protection authorities) allowing them to take part in clinical trials.

In summary, the BBC documentary appears to uncritically embrace the theories of AIDS denialists who believe that all HIV treatments are toxic. Their primary sources of information have no scientific or medical credibility. Neither the BBC piece nor the set of Scheff articles upon which the documentary was apparently based cite any mainstream experts in HIV or human subjects research - no appeal to the FDA, no experts from the National Institutes of Allergies and Infectious Diseases. They're not credible.

There is definitely a place for thoughtful argument about whether parents have the unrestricted right to withhold medical treatment from their children. There is a place for thoughtful argument about how to balance concerns about quality of life and treatment-related toxicity with the need for HIV treatment. But the BBC documentary and its source articles hardly provide that kind of thoughtful argument. Don't get sucked in.

Tax Shifts

Much has already been said in the lefty blogosphere about Bush's new plan to pay for deep cuts in taxes on investment income by eliminating deductions for state and local taxes, plus business tax deductions for employer-provided health insurance. Dan Froomkin (writing in the Washington Post) has a pithy summary of the commentary:

As far as trial balloons go, however, this one has some diabolically clever politics to it. Consider who would be the big losers if state and local tax deductions were eliminated: People living in high-tax, high-services cities, counties and states. Most of those, I'm willing to bet, are blue-voter territory.

As for reducing the incentive for employers to provide health insurance, I guess that the ensuing loss of health coverage would -- among other things -- increase demand for tax-free health savings accounts?

45 million Americans lack health insurance, and the percentage of Americans under age 65 with employer-provided coverage is declining. Most people would probably look at that situation and conclude that the last thing the country needs is to take away incentives to provide employees with health coverage, but then, most people don't have the profound analytic capabilities of "America's first CEO president."

The Bush Administration champions "Health Savings Accounts," in which people are allowed to place money into tax-free accounts to pay for health care deductibles and uncovered expenses. The idea is supposed to be that health care magically becomes cheaper because patients don't waste money on unnecessary medical visits and procedures.

The idea of getting consumers to bear the upfront costs of medical care is that they will spend more responsibly because the money is coming from their own pocket. Maginnis said early figures with the high-deductible plans show a 20 percent drop in spending. "People are being more careful," he said.

But it is unclear whether policyholders are trimming back on frivolous procedures or on medical care they may need.

No, in fact, it isn't unclear at all.

If you have employer-sponsored health insurance, cast your memory over the things they have recently paid for. Did any of it involve "frivolous procedures?" Did you have medical procedures just for the fun of it, or take prescribed-and-covered medications recreationally? Are your insurance company's rules so loose and easy that they'll cover any damn thing, regardless of its medical necessity? Me neither.

The AMA knows what people cut when they have no insurance, or incredibly high deductibles: ongoing care and monitoring for chronic diseases, diagnostic tests, checkups, well-child visits, preventive care. Frivolous expenses like that. Patients "ration out" their blood-pressure medicine, taking half the dosage to make it last twice as long. (Yes, I have seen this many times.) They don't want to pay for ongoing Pap smears, so they wind up with carcinoma in situ . And they wind up in the ER with complications from untreated chronic problems, requiring care that is considerably more expensive than the ongoing management they thriftily refused.

This is not news to anyone who works in health care, or, for that matter, anyone who has been uninsured or underinsured. It is only news to the high-minded industry lobbyists who say things like, “The theme will be individual empowerment. We will see a shift to more responsibility on individuals to provide for their own health and retirement security.”"

But in any case, Health Savings Accounts will not help you if your employer decides to respond to the proposed tax code changes by dropping employee health benefits altogether. Even assuming - and it's a big assumption - that you have the disposable income to set aside savings at the maximum allowable rate ($2,600 for an individual, $5,100 for a family), a single emergency visit could easily wipe out your HSA savings. It's unlikely to be enough money to purchase an individual insurance policy. In short, it's no substitution for traditional medical insurance or HMO policies.

"Individual empowerment." When you hear that phrase coming from the Bush Administration, put one hand securely on your wallet and use the other hand to ward off the baseball bat.

The Military Draft Begins

They're too smart, too media-savvy, to go after nineteen-year-old college boys. But never mistake this for anything but a draft:

David M. Miyasato enlisted in the U.S. Army Reserve in 1987, served three years of active duty during the first Gulf War and received an honorable discharge in 1991. He remained on inactive status for five more years, until 1996. Since then, the Kaua'i resident has married, started an auto window tinting business and this year, he and his wife had their first child.

But in September, Miyasato received a letter from the Army recalling him to active duty and directing him to report to a military facility in South Carolina on Tuesday.

Or this:

Pistorius was honorably discharged from the Army in July 20, 2001. His certificate of release attests to his accomplishments: Army Achievement Medal, National Defense Service Medal, Sharpshooter qualification. The upper corner is the spot in which the military lists a departing member's reserve obligation, the amount of time discharged soldiers, sailors and Marines remain subject to recall. For Pistorius, the boxes contain a succession of zeroes.

Because he was discharged well after his prior reserve obligation had passed, the Army laid no further claim to him, until someone in St. Louis ignored those zeroes and went hunting for a fresh body to fill a manpower shortage that grows more painful with every Iraqi sunset.

"They basically told me that my Marine Corps time doesn't count as military service," Pistorius said. Faced with a threat of AWOL charges, and worried that a spotless military record was about to be stained, Pistorius headed last month to Camp McGrady in South Carolina.

This New York Times article has more context, although it confuses matters by mixing together the stories of former soldiers who (understandably) never thought their Individual Ready Reserves obligations would be called in, and those who have legitimately discharged all military obligations. The NY Times article also makes it clear that veterans with the wherewithal to sue are generally able to extricate themselves from the draft - leaving the less informed and those with fewer resources bound for Iraq.

I've long argued that a military draft is unlikely because the military themselves don't want it. The modern U.S. armed forces are not looking for untrained cannon fodder. But this backdoor draft removes the military objection to the draft; while Pistorius and Miyasato may be rusty and out-of-shape, they have the skills, training, and experience needed to be soldiers. And calling them up for active duty doesn't sound like a draft to the average reporter or citizen on the street. They're soldiers being called back to active duty. Surely that's different from Joe College getting a letter from his draft board, right?

Wrong.

Pistorius and Miyasato are civilians. They owe the military no further service. The military has precisely as much right to call them up for active duty as it has the right to call up pregnant, disabled, thoroughly civilian me. These stories are not about a "recall to active duty," they are about a draft.

A Colonel Hart, in the NY Times story, responds to the successful lawsuits by declaring them proof that "the system works." But Pistorius' story makes it clear that even those veterans who eventually manage to avoid the draft have suffered harm from the attempt to deprive them of their liberty:

Suddenly, on Nov. 5, Pistorius was ordered to pack up. He was driven to the airport and told he was going home. At the last minute, he was handed a letter declaring: "You are released from active duty, by reason of physical disability." He had already packed up the pre-deployment assessment that said precisely the opposite. The letter also says he's subject to reserve obligation until Feb. 26, 2006.

The Pistorius family, with its three children, ages 6, 5 and 2, is now trying to figure out what to do without a month's wages. "I just put everything off," Wendy Pistorius said. "I paid only the bills I absolutely had to."

The Army took back the family separation allowance he was given when called to Camp McGrady. Frederick Pistorius is working a swing shift at the local tube plant and trying to figure out if the Army still considers him a reservist and if he's going to get another letter from St. Louis.

"I don't want to get arrested in front of my kids," he said.

...

If it ain't over 'til it's over, then why do I feel so awful?

The Bush camp, of course, is pushing the "victory is inevitable" line. On the one hand, I think it's irresponsible of CNN to treat that as if it's, you know, news. (The banner headline at cnn.com right now says "Bush camp certain of win.") On the other hand, for Kerry to pull out a win in Ohio, he'd have to damn near sweep the provisional ballots and the remaining absentee ballots. I don't think that will happen.

Right now I am fighting despair, and losing badly. It comes down to this: if we can't beat this guy, then who could we beat? If we can't make gains in this Senate, if we can't beat Bunning and Coburn, then what do we have left to hope for?

Election Protection

Kos has an update on the battle against Republican vote suppression tactics in Ohio.

Moveon.org offers resources on voting rights and election protection, including a link to this list of the 30 states which require employers to give workers time off to vote.

Over at Gallimaufry, Mary Kay tells us what we can do to protect the right to vote. Frequent Otters commenter Pat Greene offers links to voting rights resources for every state in the nation. Pat and Mary Kay are each traveling to battleground states to work as election monitors - we here at Respectful of Otters give them both a hearty round of applause.

Finally, if you are challenged at the polls on Tuesday, a toll-free hotline has been set up at 1-866-OURVOTE.

"Widespread Vote Fraud:" Applying Some Common Sense

Lots of accusations of Democratic vote fraud are flying around these days, even before the election has happened. Let's apply a little common sense to the three major pieces of "evidence" presented for challenging Democratic voters.

People are registering at addresses where they don't live, as evidenced by returned mail.

The Republican Party of Ohio sent registered letters to tens of thousands of newly registered voters. A lot of those letters came back as undeliverable, which the Republicans claim is prima facie evidence that those voters don't exist at those addresses.

But what happens when someone tries to deliver a registered letter, and you aren't home? Around here, the mail carrier leaves a little slip inviting you to pick up the letter at the post office. And my carrier always notes who the letter is from.

Now imagine that you're a Democrat, and you get a registered letter from the Republican Party. Why on earth would you go all the way down to the post office and wait in line to pick it up? What could the Republican Party possibly have to say that you'd be interested in reading? Most likely, you ignore the letter. Eventually, the post office returns it to the sender as "undeliverable." And your vote gets challenged as fraudulent.

When Catherine Herold received mail from the Ohio Republican Party earlier this year, she refused it.

The longtime Barberton Democrat wanted no part of the mailing and figured that by refusing it, the GOP would have to pay the return postage.

What she didn't count on was the returned mail being used to challenge the validity of her voter registration.

Herold,who is assistant to the senior vice president and provost at the University of Akron,was one of 976 Summit County voters whose registrations were challenged last week by local Republicans on behalf of the state party.

She went to the Board of Elections on Thursday morning to defend her right to vote and found herself among an angry mob -- people who had to take time off work to defend their right to vote.

After hearing some of the protests, the board voted unanimously to dismiss all 976 challenges.

(Via Atrios and Jerome, at MyDD.)

There are more registered voters than eligible voters in some Ohio cities.

What happens when you move, and have to re-register to vote at your new address? You fill out a voter registration card and send it in. The elections board adds you to the rolls for your new precinct and notifies your old precinct that you're no longer registered there. Eventually, your old precinct takes you off the rolls. But that process isn't instantaneous. There's nothing unusual or improper about voters temporarily appearing on the rolls twice, while the bureaucracy grinds through the process of removing them from their previous precinct of record. In particular, it's not surprising that, as voter registration deadlines approach, elections boards are more concerned about adding people to the rolls than they are about removing them from the rolls.

None of this adds up to fraud until a voter actually votes twice. And none of it is under the control of individual voters or organizations conducting voter registration drives. When I moved from the suburbs to the city, it wasn't up to me to tell my suburban precinct not to let me vote there anymore. It was up to the elections board. Did my name appear on the rolls of my suburban precinct for the primary election, when I voted in the city? I have no idea. I didn't try to vote there. So even if my name were on the rolls twice, no fraud was committed.

People have been submitting voter registrations under names like "Mary Poppins" and "Mickey Mouse."

That's what happens when you pay your voter registration workers by the completed form, instead of by the hour. This is perfectly well known, which is why most legitimate voter registration organizations don't give employees or volunteers incentives to forge registrations. Sure, it's fraud on the part of the guy standing outside the supermarket with a clipboard - but is it really going to lead to voter fraud? Could it really be part of a Democratic scheme to stuff the ballot box? I can't see how.

Let's try to imagine how that scenario would play out, shall we?

Someone shows up at the polls in a swing state and tells a pollworker, "My name is Mickey Mouse."

And the pollworker says... "Okay, Mr. Mouse, here's your ballot." The pollwatchers on hand from either party look on, sipping their coffee in unsuspecting bliss.

In what universe would it actually happen that way? Anyone trying to cast a ballot as "Mickey Mouse" is going to be immediately challenged by pollworkers, who, while they may be elderly in most precincts, are hardly so culturally illiterate as to not have heard of the most famous American cartoon character of all time. And even if you imagine a corrupt or clueless pollworker allowing "Mr. Mouse" to pass by unchallenged, it's hard to imagine the partisan pollwatchers doing the same. It is simply ridiculous to imagine that fraudulent ballots could be cast under famously fictional names. And it's even more ridiculous to imagine that Democrats would pursue such a boneheadedly transparent strategy in an attempt to steal the election.

Are Republicans legitimately picturing a smoke-filled room full of Democratic operatives cackling, "we'll register every character in the Disney archive! No one will ever catch on! Our plan is foolproof!" ...Of course they aren't. They're just trying to confuse the issue and set up the rationale for a preemptive challenge of a Kerry victory.

The DLC's New Donkey reminds us that the Ohio vote suppression efforts have Karl Rove's fingerprints all over them, and reminds us of what to expect next.

Advice For The Amoral

If you're going to try to pull off a slimy election trick, you need to do it right.

Say, for example, that you want to accuse your Democratic opponent of distributing hideous flyers that make fun of developmental disabilities. You could have one operative sneak a stack of the flyers into Democratic headquarters, and then send another operative in to "find" them and start an enormous public outcry. Instant media frenzy! Big embarrassment for your opponent!

Sounds simple, right? But, well, okay. I don't want to sound like I think I know more than you do, just because I have a Ph.D. and all, but trust me, this is important: in order for the trick to work, when your second guy goes in to "find" the nasty fliers, they have to still be there.

Looks like the Tennessee congressional campaign of Republican Dave Dahl missed out on that one crucial requirement.

"Someone brought them in and they left. I looked at them and said, 'This is not something we need in here. This goes in the trash,' " she said. "Well, here comes a man up and raising Cain and Mr. (David) Reynolds (the other volunteer) told him they were out in the trash. He went and picked it out of the trash and said, 'Well, this is going in the paper.' "

Both Dahl's campaign and the Traditional Values Coalition insisted that their information about the flyer came from a guy who apparently knows nothing about it.

As Nick Confessore points out, even without the stupid mistakes, nothing about the story passes the smell test.

Think about the phrasing of the flyer. Who on earth is it supposed to convince? People who were planning to vote for Bush but, on reflection, decide they won't want anyone thinking they're a retard? Please. The point of the flyer is to tick off and motivate Bush supporters, while dismaying and demotivating Fitzhugh's supporters and also making it hard for him to win ticket-splitters.

Yeah, we all know one or two really stupid fringe liberals who might make a flyer like this and post it online. But Dahl and the TVC claim that the Dems happily distributed the flyer from their central headquarters for two weeks. In what universe of real people who are paid money for their political expertise would that actually happen?

Update: Kieran writes about this issue at Crooked Timber, in a post that is superior to mine for two reasons: (1) it is much, much shorter, and (2) it refers to "the old pig-fucker strategy."

Republicans Fund Massive Vote Fraud in Nevada

Employees of a private voter registration company allege that hundreds, perhaps thousands of voters who may think they are registered will be rudely surprised on election day. The company claims hundreds of registration forms were thrown in the trash. [...]

The out-of-state firm has been in Las Vegas for the past few months, registering voters. It employed up to 300 part-time workers and collected hundreds of registrations per day, but former employees of the company say that Voters Outreach of America only wanted Republican registrations.

Two former workers say they personally witnessed company supervisors rip up and trash registration forms signed by Democrats. [...]

"We caught her taking Democrats out of my pile, handed them to her assistant and he ripped them up right in front of us. I grabbed some of them out of the garbage and she tells her assistant to get those from me," said Eric Russell, former Voters Outreach employee.

Eric Russell managed to retrieve a pile of shredded paperwork including signed voter registration forms, all from Democrats. We took them to the Clark County Election Department and confirmed that they had not, in fact, been filed with the county as required by law.

The company has been largely, if not entirely funded, by the Republican National Committee. Similar complaints have been received in Reno where the registrar has asked the FBI to investigate.

Most likely, any FBI investigation will be put off until after the election - just as the Florida "felons" wrongly purged from the voter lists in 2000 didn't have their voting rights restored until after the 2002 election was safely passed. What will happen in the meantime?

Needless to say, Nevada's a swing state - estimated by CBS news to be a "toss-up" with less than a month to go before the election. Voter registration closed today. The hundreds or thousands of disenfranchised Democrats appear to have little recourse - unless Republican governor Kenny Guinn steps in to extend the voter registration deadline. Governor Guinn's contact information can be found here.

The Credibility Gap

Nick Confessore at Tapped links to a video clip of an outstanding two-minute speech by Ohio Representative Tim Ryan. (Alternate link here in mp3 format, courtesy of a MyDD reader.)

Ryan is debating the infamous HR 163, Chuck Rangel's draft reinstatement bill of January 2003. Apparently, it finally came to the attention of House Republicans that Americans find rumors of an upcoming draft to be both credible and frightening. Now, Republicans and their supporters are falling all over themselves to dismiss the foolishness of the "draft hoax." Hasn't Bush promised never, ever to reinstitute the draft? Don't we trust him?

Tim Ryan doesn't.

The same people that told us that Saddam Hussein had something to do with 9/11; the same people that told us Saddam Hussein had weapons of mass destruction; the same people that told us we were going to be able to use the oil for reconstruction; the same people that told us we were going to be greeted as liberators, not occupiers; the same people, the same president that told us the Taliban is gone; the same president that told us Poland is our ally two days before they pulled out; the same president that told us Iraq is going just great; the same president that told us the economy is going just great; the same people that told us the tax cut was going to create millions of jobs; the same people that told us the Medicare program was going to cost $400 billion when it really cost $540 billion.

SO PLEASE FORGIVE US for not believing what you're saying. Please forgive the students of this country for not believing what you're saying. Not one thing, not one thing about this war that's been told to the American people, that's been told to these college students, has been true. Not one thing.

But my transcript doesn't do him justice. Watch or listen to the speech.

Update: BlogPAC is raising money to run the Ryan clip as an online ad. Please consider contributing.

October Conflicts

We here at Respectful of Otters are having much more trouble deciding what to watch on TV this season than you would ordinarily expect for a political blogger. This is Presidential Debate season, full of exciting head-to-head contests between Bush and Kerry, Cheney and Edwards. It's the final countdown to the election, and commentators - even part-time, amateur commentators like me - have no business taking their eyes off the ball even for a minute.

But this is also the baseball postseason, and we here at Respectful of Otters are the kind of people who reschedule the observance of their own birthday to ensure that it falls on a World Series off day.[1]

So I watched about half of the Cheney-Edwards debate last night - the foreign policy half - and then switched back to the Minnesota Twins' thrilling 2-0 defeat of the hated New York Yankees.

I was hoping to be wowed by Edwards, and I wasn't. But I think he held his own in the foreign policy section, and I enjoyed watching him use his rhetorical skills to keep Cheney's feet in the fire - without diminishing any of his own charm. (I guess trial lawyers get a lot of practice at that.) It looks like undecided voters were pleased with Edwards as well.

I was hoping to be wowed by Johan Santana's pitching, and I kind of was. He didn't have his killer changeup last night - apparently it was just too cold in Yankee Stadium - and he allowed a lot of baserunners. But it's hard to argue with a shutout of the team with the best winning percentage in baseball.

Here are my predictions:

In the ALDS, Boston beats Anaheim and Minnesota beats New York. Anaheim did a phenomenal job down the stretch, but their offense can be summed up in two words: Vladimir Guerrero. Boston's talent pool goes much deeper. I know that the Yankees have some sort of creepy playoff juju - George Steinbrenner must sacrifice goats, or something - but they just don't have the starting pitching this year.

Over in the National League, I think St. Louis is untouchable. They'll blow past the Dodgers without appearing to break a sweat. The Braves will manage to beat the Astros despite having sold off virtually every one of their best players. Chipper Jones and J.D. Drew will lead them to the NLDS victory; the most we can expect from their starting pitching is competence.

In the ALCS, I like Boston over Minnesota, mostly because I think that the Red Sox will lose in the most painful way possible for Boston fans. Since they won't be playing the Yankees in the ALCS, they'll make it all the way to the World Series, stirring up major hopes all across New England. There they'll meet St. Louis, who will trounce the Atlanta Braves in the NLCS.

St. Louis takes the World Series. Steinbrenner fires Joe Torre and makes a major offseason play for Nomar Garciaparra, instead of doing the sensible thing and building up the rotation. Despite his World Series ring, Albert Pujols begs to be traded to an AL team so that he has a shot in hell of winning the MVP award in a league not including Barry Bonds. Cubs and the Red Sox fans Just Wait 'Til Next Year. Again.

(Speaking of the long-disappointed hopes of the Red Sox, a fascinating article at ESPN exposes the sordid anti-Semitic roots of the "Curse of the Bambino." It's well worth reading, whether you believe in the Curse or not. I was also startled to learn from the article that the Curse is a relatively recent invention, with the first print references appearing in the mid-1980s.)

A final note: Congratulations to my Significant Otter, whose fantasy baseball team, the Key Largo Fighting Sandcrabs, finished a respectable third in their fourteen-team league. Go, Sandcrabs!


[1] We here at Respectful of Otters kind of wish that we'd never picked up the habit of saying "we here at Respectful of Otters," considering how badly we keep getting tangled in syntax problems.

Where's The Outrage?

Briefly mentioned in Dan Froomkin's White House Briefing, this story should be everywhere. No member of the Bush Administration should be able to appear in public without being asked about it. Democrats should consider tattooing this Condoleezza Rice quote on their foreheads.

One of the most-cited gotchas from Thursday was Bush's assertion that "the A.Q. Khan network has been brought to justice."

But CNN reports that national security adviser Condoleezza Rice, appearing on Late Edition, "said Bush did not misspeak when he said that the network of Pakistan's A.Q. Khan -- the founder of Pakistan's nuclear program who was caught selling secrets on the global black market -- had been 'brought to justice.'

"Khan is living in a villa and was pardoned this year by Pakistani President Pervez Musharraf. None of Khan's co-conspirators have been brought to trial."

Here's how Rice explained it, from the Late Edition transcript.

"A.Q. Khan is out of business and he is out of the business that he loved most. And if you don't think that his national humiliation is justice for what he did, I think it is. He's nationally humiliated."

These people are fundamentally unserious about the War on Terror. There's no other explanation for why the National Security Adviser would consider the "humiliation" of being driven out of business to be adequate punishment for selling nuclear secrets. Peaceful protesters at the Republican National Convention got harsher punishment than that.

Where are the warbloggers on this one? If Rice were a Democrat, they'd be calling for her head.

"Global Test:" The Vocabulary Test

In the immediate post-debate coverage, a murmur went through the lefty blogosphere that perhaps Kerry shouldn't have used the words "global test." Perhaps, despite Kerry's stellar overall debate performance, the Bush campaign would be able to tear him down by focusing their rage and contempt on those two words.

Bingo.

President Bush said Saturday Democrat John Kerry's debate remark that U.S. preemptive military action should be subject to a "global test" would give other nations a veto over American national security decisions. [...]

"When our country's in danger the president's job is not to take an international poll. The president's job is to defend America," Bush said.

The further-right wing have taken up that ball and run with it, of course, because the whole idea of a global anything pushes their UN/black helicopter/world government buttons. The temptation for the left, of course, is to respond to these attacks by defending internationalism.

But am I the only one who didn't read Kerry's words that way at all?

No president, though all of American history, has ever ceded, and nor would I, the right to preempt in any way necessary to protect the United States of America.

But if and when you do it, Jim, you have to do it in a way that passes the test, that passes the global test where your countrymen, your people understand fully why you're doing what you're doing and you can prove to the world that you did it for legitimate reasons. [emphasis mine.]

The word "global" is often used as a synonym for "international," yes. But it's also the opposite of "specific." I think Kerry meant to use the word in that second sense. I think he meant that there are no specific parameters under which you can say that preemptive war is okay - that instead, there's a global, or overarching, requirement that you must be able to prove that your rationale is sound and evidence-based. No other interpretation makes sense in light of the rest of the clause, which refers to the opinions of "your countrymen, your people." It's also consistent with the Kerry campaign's restatement of his point:

Kerry spokesman Phil Singer defended Kerry's comment by saying: "The global test is not asking for a permission slip. It's making sure that your decisions stand up to scrutiny and are backed by facts."

At the debate, Kerry unfortunately went on to give an internationalist example, flowing from the second part of his sentence - "you can prove to the world that you did it for legitimate reasons." He contrasts the international credibility the U.S. had during the Cuban Missile Crisis with the embarrassment of Colin Powell presenting "evidence" to the United Nations that the Administration already knew was highly suspect. It's an excellent example, but it does add ammunition to the Bush campaign's misinterpretation of his point.

What was Bush's initial response to the "global test" remark? He said:

Let me -- I'm not exactly sure what you mean, "passes the global test," you take preemptive action if you pass a global test.

I think that's true. I think that Bush heard "global," thought "international," and was not aware that the word "global" has an additional meaning. And actually, I blame Kerry for using a word that was open to misinterpretation. Now, I use the word "global" in the sense of "general" all the time - I might describe a patient as having "global deficits in cognition," for example - but in a foreign policy debate, you can't really blame people for thinking of the actual globe.

William Saletan is trying to put the focus back where it belongs.

Listen to Bush's words again. "The president's job is not to take an international poll," he says. "Our national security decisions will be made in the Oval Office, not in foreign capitals." Bush doesn't say these decisions belong to the United States. He says they belong to the Oval Office. He frames this as patriotism, boasting that he doesn't care whether he offers evidence sufficient to convince people in France. He shows no awareness or concern that evidence is also necessary to convince people in Ohio. He says it isn't his job to take a "poll," to hear what others think. He needs no validation.

Let's hope it sticks, but I don't think it will. The echo chamber of the press is awfully strong.

Some Speeches: More Free Than Others

Al Lorenz is an NCO with 20 years of service, currently serving in Iraq. He wrote a blistering piece about the war for a libertarian web magazine, entitled "Why We Cannot Win."

I have come to the conclusion that we cannot win here for a number of reasons. Ideology and idealism will never trump history and reality. [...]

Because the current administration is more concerned with its image than it is with reality, it prefers symbolism to substance: soldiers are dying here and being maimed and crippled for life. It is tragic, indeed criminal that our elected public servants would so willingly sacrifice our nation's prestige and honor as well as the blood and treasure to pursue an agenda that is ahistoric and un-Constitutional.

Needless to say, this created a great deal of controversy, with some arguing that Lorenz's comments might harm the war effort or tarnish America's reputation abroad. But Defense Secretary Donald Rumsfeld leapt to Lorenz's defense.

The defense secretary said he could not prevent military officials from making controversial statements.

"We're a free people. And that's the wonderful thing about our country," Rumsfeld said. "I think that for anyone to run around and think that that can be managed and controlled is probably wrong. Saddam Hussein could do it pretty well, because he'd go around killing people if they said things he didn't like."

Oh wait. That's not what happened. Actually, the military chain of command is planning to bring charges against Lorenz for "making a statement with the intent to promote disloyalty or disaffection toward the U.S. by any member of the Armed forces" or perhaps for "the conduct of partisan political activity." (There ought to be a long line-up for that charge, given that, as Kos points out, 3% of the delegates to the Republican National Convention were apparently ative duty military.)

The Rumsfeld quote actually refers to Lt. Gen. William Boykin, and his habit of giving public speeches, in full Army uniform, in which he explicitly defined the War on Terror as a religious war between Christianity and Islam. Sure, Boykin's speeches fed ammunition to the Al-Jazeera propaganda machine, and sure, they didn't look very good from the perspective of our Islamic allies, but what could anyone do about that pesky right of the serving military to unrestricted free speech?

I guess that between then and now, they found some solutions. No, wait, I'm wrong again: they had those solutions then.

Soft On Terrorists

In August of this year, while the cable news channels breathlessly interviewed and re-interviewed the Swift Boat Veterans for Truth, three convicted terrorists entered the United States.

Recently released from prison by a questionable Third World government, the three men had been tried and convicted for a plot to detonate 33 pounds of explosives at a university while a prominent world leader was speaking. It wouldn't exactly have been what you could call a surgical strike. Hundreds might have died - diplomats, students, janitors, cops - had their plan not been discovered in time.

Nor would that have been their first terrorist attack. One of them had fired a bazooka at a government building in New York. All three had been implicated in the murder or attempted murder of government officials. Their fourth compatriot in the university assassination plot, who is still at large and is known to be traveling on a false U.S. passport, escaped from prison after blowing up an airliner, killing 73 people. He also planned hotel bombings in which several tourists died.

How did these men, these convicted terrorists, these hardened criminals with no respect for life, manage to sneak into the U.S.? How did they slip the tight post-9/11 Homeland Security cordon? What wily methods did they use to evade the all-searching, tough-on-terrorism eye of George W. Bush?

They didn't.

After their release, three of the four immediately flew via private jet to Miami, where they were greeted with a cheering fiesta organized by the hard-line anti-Castro community. Federal officials briefly interviewed the pardoned men — all holders of U.S. passports — and then let them go their way. [...]

So far, not a single White House, State Department or Homeland Security official has expressed outrage at Panama's decision to put terrorists back on the world's streets. The FBI appears to have no plans to lead a search for Posada [Otter's note: the one who is still at large] so he can be returned to Venezuela, where he is a wanted fugitive. U.S. Citizenship and Immigration Services, which has rounded up and expelled hundreds of foreigners on the mere suspicion of a terrorist link, has indicated no intention to detain and deport Novo, Jimenez and Remon.

Oh yeah, I guess I left something out. These guys were anti-Castro terrorists, and most of the civilians they killed were Cubans or pinko fellow travelers visiting Cuba. And the people who would've been killed in the university bombing were tainted as well, being the kind of people who would be willing to attend a summit with a Communist. So that's all right, then.

Plus, George Bush really really needs to win Florida, or he won't be able to continue his stalwart efforts to, what was it again? Oh yeah: to "create conditions so that those who use terror as a tool are less acceptable in parts of the world."

Yeah. Maybe that's the sort of thing that ought to begin at home.

(Via Daily Kos)

Right To Life

It's easy to think that "partial-birth abortion" laws could never affect you, or a woman you care about. The right wing circulates lurid, sensationalized descriptions of the procedure that can give even pro-choice people the squeamish sense that "you have to draw the line somewhere," and that it might be okay to draw it there... or at least, that the real focus should be on preserving access to first trimester abortions.

If that sounds familiar, read this essay - and I guarantee that you will never feel that way again.

It's a first-person account by a journalist who discovered, at 19 weeks' gestation, that her much-wanted baby had died in utero. By far the safest option for removing the dead baby while preserving the mother's health and her fertility was the procedure called "dilation and extraction," known in political circles as "partial-birth abortion." The D&E had a 4% risk of serious complications, the alternative procedure 29%. The problem, in the wake of Bush's 2003 "partial-birth abortion" ban, was finding someone to do the procedure.

When I arrived at the university’s emergency room, the source of the tension was clear. After examining me and confirming I was bleeding but not hemorrhaging, the attending obstetrician, obviously pregnant herself, defensively explained that only one of their dozens of obstetricians and gynecologists still does D&Es, and he was simply not available.

Not today. Not tomorrow. Not the next day.

No, I couldn’t have his name. She walked away from me and called my doctor.

“You can’t just dump these patients on us,” she shouted into the phone, her high-pitched voice floating through the heavy curtains surrounding my bed. “You should be dealing with this yourself.”

Shivering on the narrow, white exam table, I wondered what I had done wrong. Then I pulled back on my loose maternity pants and stumbled into the sunny parking lot, blinking back tears in the dazzling spring day, trying to understand the directions they sent me out with: Find a hotel within a few blocks from a hospital. Rest, monitor the bleeding. Don’t go home — the 45-minute drive might be too far.

She walked around for a week, bleeding, with her dead baby inside of her, because the virulent political controversy around dilation and extraction meant that no one was willing to provide her with proper medical care. This could happen to me. This could happen to any woman.

(Via Ms. Musings.)

I Should Also Say...

...that I had a great time at Worldcon. I got to meet some fabulous bloggers for the first time - Charles Dodgson (who, strangely, I had always imagined looking a lot more like a Tenniel illustration), Charlie Stross, Trish Wilson - and also got to renew my acquaintance with others, like Mary Kay Kare of Gallimaufry (who throws a great party, and has excellent taste in single malts - not that it did me any good, alas), Kathryn Cramer, and Patrick and Teresa Nielsen Hayden. (I met Patrick and Teresa for the first and last time three years ago - it should definitely be a shorter amount of time before we meet again.)

The unexpected thing about being at Worldcon was that I got to meet a bunch of my readers. See, in the back of my head I still think of this blog as something that's read by about two dozen people, all of whom know me personally. I know it's not true, but it's what my mental map looks like. So it was simultaneously strange and cool to have all of these strangers come up to me and say, "Oh, Respectful of Otters! I read you all the time!" In a weird way, I think it renewed my commitment to blogging. For most of the summer now I've been idly starting posts in my head, and then thinking "Ah, why bother." Now I have specific faces in mind when I think "why blog?" I hope that will help keep my posting frequency up.

Special mention goes to Xopher, who (a) is the only reader I met whom I am sure it's okay to mention by name, and (b) was officially the first person ever to rub my pregnant belly. (No, I'm not showing yet.)

The Writings Of Dead Men

By now, I'm sure that everyone's seen the memos, unearthed by 60 Minutes, in which Bush's Texas Air National Guard commander complains that he is receiving pressure from upstairs to "sugar coat" Bush's performance evaluation, mentions that Bush wants to know "how he can get out of coming to drill," and suspends him for "failing to perform to U.S. Air Force/Texas Air National Guard standards." (If you haven't, the PDF files are in the sidebar to the linked article.)

Setting aside for a moment the forgery claims - because those arguments don't seem particularly credible to me - I was struck by the main theme of the Bush Administration defense.

Q: What about these two official documents signed by Jerry Killian is rumor and innuendo?

DAN BARTLETT: Well, it's impossible for anybody to read the mind of a dead man. Jerry Killian writes memos to himself in this file -- [...]

Again, we're trying to suggest the comments were the orders of somebody who is no longer alive. [...]

DAN BARTLETT: For anybody to try to interpret or presume they know what somebody who is now dead was thinking in any of these memos, I think is very difficult to do. [...]

Q: So there is certainly some opinion out there among former members of the military that these documents do indeed describe how Killian felt, what Killian thought about the situation.

DAN BARTLETT: Well, again, these are people --

Q: So it's not really open to interpretation --

DAN BARTLETT: Well, it is. It is. And when you're talking about a memo to somebody's self, this is a memo to his own file, people are trying to read the mind of somebody who is no longer with us. [...]

Q: Killian writes and voices an opinion here that he believes that the President was talking to someone upstairs about his transfer.

DAN BARTLETT: Again, that is conjecture on a part of somebody who is no longer with us. [...]

Got that? It's impossible for anyone to say what Col. Jerry Killian meant by the words he wrote, at least without the use of a psychic channeler or a ouija board, because Killian is dead. He's been dead for ten years, which is certainly long enough for his cryptic writings to sink into the mists of the impenetrable past.

I suppose that's a reasonable philosophical position. I just think it's strange that the same Administration champions a strict constructionist view of the U.S. Constitution, in which the writings of men two hundred years dead are held to be an entirely complete and sufficient blueprint for the past, present, and future of American law.

So Where Am I Going?

I'm off to Worldcon, the World Science Fiction Convention, tomorrow. I expect that I won't have time to post, but I will be checking my Respectful of Otters e-mail. After I return on Tuesday, hopefully there will be more in the way of consistent blogging.

Enjoy your holiday weekend!

So Where Have I Been?

Originally, I wasn't sure that I would post about this, but Moe Lane says that I'd be a jerk not to. And besides, it's the first day of the Republican National Convention, and I'd like to post something life-affirming. So:

It turns out that there actually is something in this world that's more obsessively all-consuming than politics - gestation. Baby otter formation has been taking up most of the time that I used to spend reading blogs, writing posts, and generally fulminating about the Bush Administration. I don't expect it to be a permanent, or even nine-months-long, condition - eventually, I am told, I'll stop wanting to sleep 22 hours a day and being nauseated by scrolling text during the other two hours. But in the meantime, I'm a little preoccupied.

Because I can't turn my political mind off completely, I've been piecing together the ways in which the the pregnancy industry lays the groundwork for a lifetime of double-bind guilt for women. Pregnant women are assigned infinite responsibility for the protection of their fetuses - without, I can't help noticing, actually having much real control.

"The first trimester is the most important part of your pregnancy, because all your baby's major body parts and organs are formed during this time." So begins the endless list of all the things you aren't supposed to do during pregnancy, from taking a hot bath to eating a ham sandwich. (There's an equally extensive and detailed list of things you are required to do. Very few things are optional.) Your responsibilities seem clear. And yet, 20-30% of pregnancies miscarry during that "most important" first trimester - and 99% of those miscarriages have nothing to do with the list of required or forbidden activities. You can, quite literally, spend every waking moment chasing after an ideal of perfect pregnancy behavior, but it won't make a damned bit of difference to whether your baby dies before you've even heard a heartbeat. Responsibility without control.

"Every time you pick up your fork, ask yourself, 'is this the best bite I could possibly give my baby?' " directs the most popular American pregnancy guidebook. White sugar is sternly forbidden for the duration of pregnancy, with dire consequences threatened for the health of your baby. And yet the same book approaches prenatal exposure to environmental toxins from a reasoned perspective that considers dose and duration of exposure, timing, proximity, et cetera. You're left with the vague impression that a Krispy Kreme doughnut will do more damage to your baby than the paint factory up the road. Why? Probably because, from the perspective of the pregnancy industry, the only important risk factors are the ones that are the pregnant woman's sole responsibility.

Bypassing the traditional medical model for the crunchy-granola model of childbirth merely trades one set of rigid behavioral expectations for another, I find as I guiltily grab a packaged yogurt smoothie from the fridge instead of spending twenty minutes making a homemade organic one in my blender. Plus, in the crunchy-granola model you get assigned a new enemy: the obstetrician, who is out to Ruin Your Birth Experience unless you prevent him via constant hawklike vigilance. I've seen women wracked with ongoing guilt and anger because their baby was briefly removed for medical treatment in the moments after birth, an experience thought to be emotionally scarring. Once again, the crushing weight of responsibility without, in fact, very much control at all.

You'd almost think it was a plot to keep women scared and guilty and focused on their own imperfections, instead of angry and political. But of course it's more likely to be the same old story: fear sells.

Can I recognize the ridiculousness of all these expectations? Mostly. It's harder than you'd think to throw them off completely, with a constant onslaught of pregnancy hormones predisposing me to heightened emotionality. But yes, for the most part I am blissfully happy. It's just that falling back into otter mode gets the suspicious, analytical part of my mind working at top speed. (That's probably a good thing, at least in moderation.)

"Over The Bridge"

Read this Arkhangel post right now.

Why are you still here? Go!

Bush On The Campaign Trail

Dan Froomkin reports on the campaign style of the most managed President in history:

Instead of taking questions from reporters, President Bush has become increasingly partial to playing talk-show host to an audience of sycophantic fans.

There were four "Ask President Bush" events last week and in each case, after a long speech and staged interviews with prepped guests, Bush opened the floor to some incredible softballs.

The format allows the president to come off as very smooth.

...which, of course, is quite the accomplishment. But, as Froomkin makes clear, the audience "questions" go well beyond softball level to outright character assassination of John Kerry - without the Bush campaign having to get their own fingers dirty:

"Q On behalf of Vietnam veterans -- and I served six tours over there -- we do support the President. I only have one concern, and that's on the Purple Heart, and that is, is that there are over 200,000 Vietnam vets that died from Agent Orange and were never -- no Purple Heart has ever been awarded to a Vietnam veteran because of Agent Orange because it's never been changed in the regulations. Yet, we've got a candidate for President out here with two self-inflicted scratches, and I take that as an insult. (Applause.)

"THE PRESIDENT: Well, I appreciate that. Thank you. Thank you for your service. Six tours? Whew. That's a lot of tours.

"Let's see, who've we got here? You got a question?"

Froomkin's thesis is that the press corps is getting tired of this kind of theater, but I'm less optimistic. Fox News will always have an endless appetite for pro-Bush quasi-news clips, and in the echo chamber of right-wing punditry, admiration of Bush's natural touch with the voters - and voters' overwhelming distaste for Kerry - will flourish undisturbed. Even in the mainstream news, the propaganda events seem to be working well enough. Froomkin himself links to this Valentine of a Washington Post article by John F. Harris, which speaks admiringly about Bush's smooth speaking style and demeanor:

In loosening his style, Bush tightened his message. Fielding friendly questions at "Ask President Bush" forums, or lathering up the crowds at pep rallies like the one here on Saturday afternoon, he presented his case for reelection with a force and fluency that sometimes eluded him at important moments over the past year.

Harris also writes that, despite polling data suggesting that the Bush campaign is embattled, in fact he is "drawing appreciative crowds" - without bothering to mention just why the crowds attending Bush rallies are so uniformly enthusiastic. Even the Froomkin piece notes that Bush events have been successful in eliminating "hecklers," instead of making it clear that Bush events have barred everyone but true believers.

CDC HIV Prevention Regulations: Reprise

Recently, Doug Ireland's April scare piece about new CDC regulations for HIV prevention activity has been given new life in the blogosphere. In the last couple weeks, I've seen the article quoted all over LiveJournal, as well as in favorite blogs of mine, such as Echidne of the Snakes. People have also started e-mailing it to me again with requests for comment.

I don't normally reprint my own stuff, but given the increased circulation of the Ireland piece, I'd like to repost a link to my analysis of the proposed new CDC regulations. In summary: I think that Ireland's piece is an alarmist and misleading distortion of what the regulations actually say, and I don't think that the proposed changes will have a negative impact on HIV prevention activities. The new regulations certainly do not restrict future HIV prevention efforts to "abstinence only" models. If you're still concerned, follow the link for my detailed analysis.

What God Hath Joined Together

Marriage is a term with legal meaning, but that's not all that it is.

Marriage is the binding of persons by sacred oaths.

Marriage shelters parents and children together in stable families.

Marriage is the means by which communities recognize relationships as legitimate, and pledge to support them.

Marriage is a declaration that two people strive for permanency of their relationship, for better or for worse, for richer or for poorer, in sickness and in health.

As I said last February: come what may, these people are married. Look at them, look at their faces. The California Supreme Court may have annulled their legal certificates, but their marriages abide. The long fight is still before them, still before us, but their marriages abide.

What God hath joined together, let no man put asunder. Some things can't be taken away.

At Last I Have Arrived

Every little girl growing up in America dreams of this moment.

Compassionate Conservatism In The ER

Via Body and Soul, I discover that the Bush Administration's conservatism just keeps getting more and more compassionate.

Hospitals are required to treat anyone who shows up in the Emergency Room with a bona fide medical emergency, regardless of that person's ability to pay. If the person can't afford to pay anything, or can't be billed because they have no legal address, the hospital is required to absorb the cost. For hospitals in border states, a disproportionate number of these indigent ER patients are illegal immigrants. These hospitals have been arguing for years that illegal immigration is the government's problem, and that the government should reimburse them for the costs of emergency care given to undocumented patients.

Last year, they managed to convince Congress to set aside some money for it, and all seemed well. But now the Bush Administration has declared that, in order to be reimbursed, hospitals must ask all uninsured emergency patients about their immigration status, including placing photocopies of immigration documents in the medical record. They won't be required to turn the records over to the government unless they are audited, but the INS and local law enforcement officials will presumably be able to access them - as they can access the rest of the medical record - via subpoena.

This policy will obviously have the effect of keeping illegal immigrants out of the ER - and probably many legal immigrants, as well. Parents who are undocumented will hesitate to bring their U.S.-citizen children to the ER, for fear that the parents' immigration status will be questioned. Legal immigrants whose papers aren't at hand, or aren't perfectly in order, will be afraid of being misidentified as illegal. No one will trust that the hospital won't notify the INS.

People won't get the emergency health care they need.

Hospitals want to use common-sense methods of identifying cases eligible for reimbursement - for example, counting all indigent patients who give invalid Social Security numbers. The Bush Administration argues that "hospitals could ask the questions in 'an unobtrusive way' that would not discourage immigrants from seeking care." As if there's an unobtrusive, casual way to ask questions like:

Are you a United States citizen?

Are you a lawful permanent resident, an alien with a valid current employment authorization card or other qualified alien?

Are you in the United States on a nonimmigrant visa of the type issued to students, tourists and business travelers?

Are you a foreign citizen who has been admitted to the United States with a 72-hour border crossing card?

One of two things will happen under this new policy. Hospitals with a serious dedication to making emergency care accessible will refuse to ask immigration questions, foregoing reimbursement. Hospitals too financially strapped to forego reimbursement, or too focused on the bottom line to care, will be avoided by anyone whose immigration status is undocumented or ambiguous. More of those people will wind up seeking medical attention from unlicensed traditional healers, or going without care altogether. But here's what won't happen: large numbers of illegal immigrants declaring their status at the ER and receiving treatment for which the hospital is reimbursed.

Once again, the Bush Administration will have it both ways: they'll get a PR boost from a policy which seems humane and compassionate, and yet they won't actually have to pay for the provision of costly services.

Why should we care? If "human kindness" isn't a sufficient answer, then we should care for reasons of public health. You don't want someone with untreated Hepatitis A in the restaurant kitchen, making your salad. You don't want a child with ringworm or an untreated infection playing with your child on the playground. You don't want there to be a population in your city which is undervaccinated, living under poor sanitary conditions, and without prompt access to health care. That's how epidemics start.